The Major Trauma by-pass clinical practice guideline has been designed to identify trauma patients that would benefit primary transport direct to a Major Trauma Centre (MTC). Studies demonstrate that identification of major trauma in the patients ≥ 65 cohort is challenging. An older adult triage tool has been included with specific decision criteria that are expected to improve patient outcomes.
All major paediatric (patients age less than 14 years) trauma (including burns) should be taken to PCH unless urgent stabilisation is required at the nearest appropriate emergency department prior to transfer to PCH.
Patients not suffering major trauma as defined in this guideline are to be transported to the hospital designated by the Ambulance Network Coordinator (ANC). Should the patient need specialised care as defined by the Clinical Distribution Matrix, the ANC should be contacted to inform them of the change of destination.
In accordance with the trauma services plan developed by the Department of Health, patients suffering major trauma should be taken to hospitals designated as Major Trauma Centres. Major Trauma should be considered in any one of the following criteria
Physiological Criteria (any of the following):
0 - 3 months | 3 - 12 months | 1 - 4 years | 5 - 11 years | 12-16 years | Adult | ≥ 65 | |
---|---|---|---|---|---|---|---|
HR | <110 or >160 | <100 or >160 | <90 or >140 | <80 or >140 | <60 or >120 | <50 or >120 | <50 or >120 |
RR | <30 or > 60 | <25 or >55 | <20 or >40 | <15 or >35 | <15 or >30 | <8 or >25 | <8 or >25 |
BP SYS | <70 | <75 | <80 | <80 | <90 | <90 | <120 |
SpO2 | <92% | <92% | <92% | <92% | <92% | <94% | <94% |
GCS | <Baseline | <Baseline | <Baseline | <Baseline | <Baseline | <Baseline | <Baseline |
Injury Criteria (any of the following):
All patient cohorts |
---|
|
High Risk Criteria (any of the following):
Adult | Older adult | Paediatric |
---|---|---|
| As for adult but inclusive of:
|
|
Older adult (≥65 years old) Head Injury Criteria |
---|
Patients in this cohort can have a blunted response to trauma. Advocate for transport to hospital if there is history of a head strike (including fall from standing) and any of the following:
|
Patients with immediate life-threat should address time-critical concerns prior to continuing with this guideline.
Brown, E., Tohira, H., Bailey, P., Fatovich, D., Pereira, G. and Finn, J., 2019. Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth. Emergency Medicine Australasia, 31(5), pp.763-771.
Crewdson K, Lockey D, Davies G. Outcome from paediatric cardiac arrest associated with trauma. Resuscitation 2007;75:29–34.
Director of Trauma Services Royal Perth Hospital / State Director of Trauma (WA).
European Resuscitation Council Guidelines for Resuscitation 2015, Section 4. Cardiac arrest in special circumstances.
Fiorelli, E., Bozzano, V., Bonzi, M., Rossi, S., Colombo, G., Radici, G., Canini, T., Kurihara, H., Casazza, G., Solbiati, M. and Costantino, G., 2020. Incremental Risk of Intracranial Hemorrhage After Mild Traumatic Brain Injury in Patients on Antiplatelet Therapy: Systematic Review and Meta-Analysis. The Journal of Emergency Medicine, 59(6), pp.843-855.
Ichwan, B., Darbha, S., Boulger, C. and Caterino, J., 2013. Evaluation for Ohio's Geriatric Specific Trauma Triage Criteria: Assessing Implementation and Improvement in Outcomes for Ohio's Elders. Annals of Emergency Medicine, 62(4), p.S115.
Lockey D, Crewdson K, Davies G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med 2006;48:240–4.172.
Luna GK, Pavlin EG, Kirkman T, Copass MK, Rice CL. Hemodynamic effects of external cardiac massage in trauma shock. J Trauma 1989;29:1430–3.170.
Newgard CD, Lin A, Eckstrom E, Caughey A, Malveau S, Griffiths D, Zive D, Bulger E. Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults. J Trauma Acute Care Surg. 2019 May;86(5):829-837. doi: 10.1097/TA.0000000000002195. PMID: 30629015; PMCID: PMC6370024.
Special focus report - Elderly major trauma patients. (n.d.). health.vic. Retrieved September 17, 2021, from https://www2.health.vic.gov.au/about/publications/researchandreports/Special%20Focus%20Report%20-%20Elderly%20Major%20Trauma%20Patients
Victorian Paediatric Clinical Network, Melbourne, Australia, The Victorian Children's Tool for Observation and Response (ViCTOR), available from www.victor.org.au
Willis CD, Cameron PA, Bernard SA, Fitzgerald M. Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury 2006;37:448–54.171.
St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.
The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.
St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.
St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website.
No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au
Where links are provided to resources on external websites, St John WA:
Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.
To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).
Please read this cookie policy carefully before using Clinical Resources from St John WA.
The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.
Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.
If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.